Individual's repayment claim

Claim for repayment of subcontractor deductions in the tax year to 5 April 2015

Use this form to claim repayment of deductions made during the tax year to 5 April 2015.

When not to use this form Use your tax return instead of this form if you are making your claim after 5 April 2015, the end of the tax year. If you are in a partnership, rather than in business on your own, ask us for claim form CIS41(2014) ‘Partner’s repayment claim’.

To make your claim: • complete each part of this form in turn, unless you are directed otherwise • keep a record of the details from the payment and deduction statements for the tax year, ready to complete your tax return after 5 April 2015 • send the original payment and deduction statements to us at the above address, together with this fully completed form We will work out any repayment you are due.

How to decide when to claim repayment Complete this part first to help decide if you should claim repayment now.

My business accounts which end in the year to 5 April 2015 have been prepared and the business profits are now known or the business has ceased and final accounts have been prepared. Put X in one box.

Yes ☐ No ☐

I hold the original payment and deduction statements for the tax year, fully completed by the contractor, showing the deductions made. Put X in one box.

Yes ☐ No ☐

I have paid all tax and Class 4 National Insurance contributions due. Put X in one box.

Yes ☐ No ☐

My tax affairs are up to date. (This includes sending in tax returns and Employer and Contractor payments.) Put X in one box.

Yes ☐ No ☐

If you have put an X in all the Yes boxes in this part, go to ‘Personal details’ on page 2. If you are unable to answer yes to one or more of the statements you should not make a claim now.

Please contact any HM Revenue & Customs office if you need help.

### Personal details

Complete for all claims.

1. Your date of birth DD MM YYYY

2. Are you married or in a civil partnership? Put X in one box.

   - Yes
   - No\
     If No, go to question 3 If Yes, enter your husband's or wife's or civil partner's date of birth DD MM YYYY

3. Your National Insurance number

4. Your daytime phone number (It is often easier to clear up any queries on your claim over the phone.)

### Details of the claim

We may ask for evidence to support the details you enter here.

5. Has the business ceased? Put X in one box.

   - Yes
   - No

6. Enter the date, between 6 April 2014 and now, on which either your business ceased or your business accounting period ended DD MM YYYY

7. For the accounting period ending on the date you have shown above in question 6, please enter:

   - the gross business income, excluding VAT
     - £
   - the total allowable business expenses and capital allowances
     - £
   - the net business profit (box 1 minus box 2)
     - £

8. Enter the total deductions from the payment and deduction statements for the period since 6 April 2014

   - £

9. Enter the total of any other income you have received since 6 April 2014 which has not had Income Tax deducted, treated as deducted or treated as paid

   - £

We will normally send any repayment by cheque to you at the address shown on page 1. If you want to receive repayment in this way, please continue by completing the 'Declaration' on page 3.

If you want the repayment sent to a bank or building society account, or to someone else (a nominee), complete 'Sending the repayment elsewhere' on page 3 followed by the 'Declaration'. Sending the repayment elsewhere A nomination here relates to this claim only.

Would you prefer a repayment to go to your bank or building society or to a nominee? Fill in either (a) or (b) below, then complete the 'Declaration'.

(a) Send the repayment direct to the bank or building society account, as detailed below.

Name of bank or building society

Branch sort code

Bank or building society account number

Building society reference (if applicable)

Name of the account holder

(b) Send the repayment by cheque to my nominee, shown below.

Full name and address of the nominee (use capital letters)

Name

Address

Postcode

Agent's reference (if your agent is the nominee)

Declaration Complete for all claims. False statements can result in prosecution.

I: • enclose all the original payment and deduction statements • have kept copies of the payment and deduction statements • authorise any repayment to be made to the person shown at (a) or (b) above, if applicable • confirm that the information I have given here is correct and complete to the best of my knowledge and belief

Signature

Date DD MM YYYY

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